Neurological music therapy for poststroke depression, activity of daily living and cognitive function: A pilot randomized controlled study

ABSTRACT

Introduction

Music therapy (MT) has been adapted to post-stroke rehabilitation for years and there were several theories of treatment methods. Our music therapist utilized neurological MT to design a treatment program for stroke survivors. We aimed to compare the effects of a low-dose neurological MT with no MT on outcomes measuring depression, activity of daily living and cognitive function amongst stroke survivors.

Method

A single masked, randomized controlled study was designed and patients with subacute stroke were recruited. The patients were assigned to a MT group or a conventional therapy (CT) group. Both groups received CT including physical therapy and occupational therapy. Patients with aphasia also received speech therapy. The MT group underwent an additional hour of neurological MT per week for a total duration of 4 weeks. Our MT method comprised therapeutic singing, therapeutic instrument music playing, melodic intonation therapy, and rhythmic speech cueing. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcomes were the Mini-Mental State Examination (MMSE), modified Rankin Scale (MRS) and Barthel Index (BI).

Result

Eighty-two patients were recruited. No significant differences were found at baseline. There was significant post-treatment effect among both groups for the BI (p < 0.001, Mdiff = 13.96, 95%CI = (11.64,16.29)), MMSE (p < 0.001, Mdiff = 1.04, 95%CI = (0.51,1.57)) and MRS (p < 0.001, Mdiff = −0.45, 95%CI = (−0.57,−0.34)). Additionally, a significant difference was observed between the groups for the MRS (p = 0.033, Mdiff = −0.24, 95%CI = (−0.03,0.52)). No significant between-group effect was found regarding the BI and MMSE.

Discussion

This study highlights the added value of MT in improving MRS, while requiring relatively less therapeutic time.

KEYWORDS:

• Stroke
• rehabilitation
• music therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Y. Y. Lee, upon reasonable request.

Additional information

Funding

This work was supported by grants from the Chang-Gung Medical Research Project [(CMRP number: CMRPG8F1951)].

Notes on contributors

Chia-Hsin Chou

Chia-Hsin Chou is a 3rd-year resident in the Department of Physical Medicine and Rehabilitation at Kaohsiung Chang Gung Memorial Hospital in Taiwan and also a guitarist. He is currently engaged in research related to both music therapy and kinesiology. His academic and personal passions revolve around the application of music to patients and performing arts medicine.

Po-Cheng Chen

Po-Cheng Chen is currently an assistant professor at Kaohsiung Chang Gung Memorial Hospital and serves as the deputy director of the Department of Physical Medicine and Rehabilitation at Kaohsiung Chang Gung Memorial Hospital. He obtained his Bachelor’s degree of Medicine from Chang Gung University School of Medicine and a Master of Public Health degree from the College of Public Health at National Cheng Kung University. Chen’s research focuses on longitudinal studies related to rehabilitation science and he is currently leading research on postoperative quality of life changes in patients with rotator cuff tears, as well as a longitudinal survey of the quality of life of adolescent baseball players.

Yu-Chi Huang

Yu-Chi Huang is an attending physician of Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gang Memorial Hospital, Taiwan. Her previous studies proved the efficacy of hyaluronic acid injection to treat hemiplegic shoulder pain in stroke patients. She also developed the treatment protocol for post-stroke spasticity by using elastic tapping, as well as treatment for post-stroke dysphagia by using neuromuscular electrical stimulation. In addition, her works have been critical for the advancement of Rehabilitation Medicine and have been included in the recommendation for stroke rehabilitation.

Tsung-Hsun Yang

Tsung-Hsun Yang is a doctoral researcher affiliated with the Department of Physical Medicine and Rehabilitation at the Kaohsiung Chang Gung Memorial Hospital. His research focuses on neurological rehabilitation, cardiopulmonary rehabilitation, sports medicine, and shockwave therapy.

Lin-Yi Wang

Lin-Yi Wang is a physiatrist affiliated with Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan. His research focuses on general rehabilitation, including for stroke patient, specifically the rehabilitation of hemiplegic shoulder pain. In addition to practicing as a physiatrist, he developed sonographic diagnosis to neuromusculoskeletal disorders of upper extremities resulting from repetitive motions, and he is a supervisor of the Taiwan Society of Neuromusculoskeletal Ultrasound.

I-Hsuan Chen

I-Hsuan Chen is an assistant professor affiliated with Department of Physical Therapy at Fooyin University. Her research focuses on neurological physical therapy in older adults and stroke patients. She combines biomechanical assessments of human movement with non-invasive functional neuroimaging to investigate the cortical involvement of motor control. Her interests are also to design the rehabilitative interventions that improve age-related changes or motor function following stroke via optimization of brain plasticity.

Hui-Ju Lee

Hui-Ju Lee, MT-BC, MTA, TRMT(Taiwan-registered music therapist) graduated from York University in Psychology, and the University of Windsor in Music Therapy. She started working at Kaohsiung Chang Gung Memorial Hospital in Taiwan since 2007. Her clinical focus is children with developmental disabilities, stroke, dementia, and palliative care.

Yan-Yuh Lee

Yan-Yuh Lee is a board-certified physiatrist and currently the director of the RenYi PoAi Rehabilitation Clinic in Taiwan. During his tenure at Kaohsiung Chang Gung Memorial Hospital, he dedicated a significant amount of effort to the field of neurological rehabilitation, with the aim of finding suitable complimentary alternative therapies for stroke patients.